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Practical lesson № 1
Theme: Nursing. The organization of medical
care. The structure of the hospital. Admission
department. Inpatient department.
In the centre our subject – Patient.
PATIENT
(A Latin word meaning to suffer or to bear) - Is a person who is
waiting for or undergoing medical/nursing treatment and care.
NURSING is organization of patient care.
Nursing includes three components:
1. Providing a variety of patient needs.
Patient needs: eating, drinking, washing, moving, help while defecation or urination.
2. Creation necessary conditions for the patient stay at the hospital or at home.
It means peace and quiet and also keeping beds and clothes clean.
3. Alleviating the sufferings of the patient and prevention of complications.
•
•
Nursing is a part of the patient treatment.
It is performed by the nurse and hospital attendant (junior nurse).
The main types of nursing:
1.
General nursing – is a set of measures for the care without depending on the type of disease.
2.
Special nursing - is a set of measures, which depends on the specifics of the disease, its
symptoms.
Care is administered in medical institutions.
TYPES OF MEDICAL INSTITUTIONS:
1.Policlinic. Patients served by the policlinic and at home (without hospitalization), located
in the city.
2.Ambulatory. Patients served in the ambulatory and at home (without hospitalization),
located in a small town.
3.Medicosanitary department. Task - service workers of industrial enterprises, consists of a
policlinic, hospital, health center, preventorium.
4.Dispensary - specialized institutions in which receive treatment patients with certain
pathology (tuberculosis, skin and venereal diseases, cancer etc.)
5.Station of Ambulance - provides emergency specialized medical aid around the clock.
6. Women's Consultation – carry out control and treatment of women with gynecological
diseases, and prenatal service.
7. Hospital – carry out dynamic control and treatment of patients around the clock.
8. Clinic - the hospital, which is composed of the Chair of Medical school.
9. Military hospital - a hospital for sick soldiers and disabled veterans.
10. Sanatorium - a hospital in the resort zone, where carry out therapy by natural and
physical methods.
Hospital
The functions of the hospital:
• diagnosis of diseases
• treatment of diseases
• disease prevention
The structure of the hospital:
• admission department
• inpatient departments
• diagnostic department
• pharmaceutical department
• kitchen
• laundry
• administration rooms
Types of hospitalization in Hospital :
1. Planned hospitalization.
The patient comes to the hospital in the direction of a
doctor from the policlinic or comes to the hospital
by yourself.
2. Emergency hospitalization.
The patient is admitted to a hospital in an emergency
(acute illness, trauma, injury and other)
3. Transfer from another medical hospital.
Admission department
Functions of the admission
department:
1. Registration of patients.
2. The medical examination of the patient.
3. Emergency medical aid (if necessary).
4. Determination department for hospitalization.
5. Sanitary and hygienic processing of patients.
6. Transportation of patients
THE STRUCTURE OF ADMISSION
DEPARTMENT:
1. Waiting room - a room for patients and relatives, which
should be plenty of chairs, an information board.
2. Registry - special room where to registration patients.
3. Two examination rooms - for inspection therapeutic and
surgical patients.
4. Sanitary room - for Sanitary and hygienic processing of
patients.
5. The treatment room - to perform the injection.
6. Small Operating room (bandaging room).
7. Isolator.
8. Laboratory.
9. Room for medical staff.
10.Toilet room (WC).
11.Warehouse for the storage patient’s clothes.
Registry. Registration of patients:
• the nurse records the patient data in medical documentation,
• the nurse measures the body temperature
• invites the doctor of admissions department;
Medical documents of admission department:
1. Medical hospital card (medical history)
2. Journal of registration of patients and refusal of
hospitalization.
3. Journal of examination for pediculosis.
4. Journal of registration infectious diseases.
5. Journal of telephone messages, etc.
Examination rooms. Medical examination:
• Doctor examines the patient.
• Doctor prescribes the minimum examination in
accordance with the disease.
• Doctor determines the indications for
hospitalization to hospital.
• Doctor provides first aid if the patient's condition is
severe (seriously ill).
• Doctor determines the volume of sanitization.
• Doctor determines the type of transportation .
Sanitary room . The structure of sanitary inspection room:
1. Dressing room 1 - a room where patients undress and are
inspected.
2. Shower or bathroom, where patients take a shower or bath.
3. Dressing room 2 where patients dress in clean clothes.
Clothes of patients is delivered in a warehouse.
If the patient revealed an infection, his clothes is delivered in the
disinfection chamber. The patient is placed in isolator or
hospitalized to the infectious diseases hospital.
Sanitary and hygienic processing of patients:
Types of sanitary and hygienic processing:
• complete processing
• partial processing
The algorithm Сomplete sanitary and hygienic processing:
• examination of the hair and skin (detection pediculosis);
• grooming of nails and hair (if needed);
• shaving (if needed);
• take a shower or hygienic bath.
The algorithm Partial sanitary and hygienic processing:
• examination of the hair and skin (detection pediculosis);
• partial wash and wiping the skin.
Partial processing is performed if the patient in critical
condition.
Scheme of sanitary and hygienic
processing:
SANITARY AND HYGIENIC
PROCESSING OF PATIENTS
complete processing
hygienic bath
hygienic shower
partial processing.
wiping the skin
Inspection of skin and hair of the patient
• Examination of the skin and hair of the patient is carried out
to detect lice.
• Pediculosis - the lesions of skin and hair as a result of
parasitism on the body lice.
• Pediculosis - a specific parasitism of lice on human, which
feed on its blood.
• Lice – are vectors of typhus and relapsing fever and other
rickettsial diseases.
Lice exist on our planet for about 40-50 million years.
The history of mankind has "only" about 2.5 million years.
There are about 250 species of lice.
On the body of human parasites three types of lice.
Types of lice
• The head lice - louse affects the scalp;
• Body (clothes) louse - is usually a parasite on the human clothes.
However, she lives and lays eggs (nits) in clothing and feeds on
temporarily moving from clothing on the skin.
• Pubic lice - striking surface hairy pubic area, hairy underarms,
and face - mustache, beard, eyebrows, eyelashes.
a) head lice; б) Body (clouthes) louse; в) Pubic lice
Signs of Pediculosis:
• the presence of adult insects,
• their eggs (nits),
• skin itch,
• traces of scratching on the skin
• Pediculosis is associated with poor hygiene, crowded living
conditions and exposure to other individuals with pediculosis.
• Lice can be transferred from person to person through direct
contact. It gets easily transmitted from person to person perhaps
sleeping together, sitting together etc. They can also be
transmitted through clothing, bedding,combs etc.
• The itching of the scalp is a source of discomfort to the client
causing restlessness and insomnia.
• The lice are blood suckers and cause anaemia.
• They spread the disease e.g. typhus fever, relapsing fever,trench
fever.
• Itching of the scalp results in the scalp injury and the injured area
is subjected to infection which lead to infected glands.
Prevention of pediculosis
• Prevention is easier than controlling. For this,proper
personal hygiene concept should be practiced by
everybody in their lives. Combing the hair
daily,washing it frequently, keeping the skin and
clothing clean will solve the problem. Any client
complaining of itching or if scratches the head,needs
thorough examination of the hair and scalp,body and
linen to discover lice. If lice are found on the client’s
head or body,follow the prescribed treatment.
Processing hair of the head with pediculosis
Preliminary assessment
•
check the physician's order to see the specific precautions for the client movements and positioning.
•
assess the general condition of the client and ability to follow directions.
•
assess the condition of the scalp and the hair.
Equipment (articles)
1.
Protective clothes for nurse (medical gown, additional medical gown, medical cap, oilcloth apron, gloves)
2.
The solution against lice. For example - Parasiticide ("Nittifor" "Medifoks", etc.)
3.
Vinegar (6% acetic acid solution)
4.
Hair comb
5.
Oilcloth
6.
Kerchief
7.
Shampoo
8.
Towel
9.
Laundry bag
10. A container with a disinfectant solution
Preparation of the patient:
1.Explain the procedure to the patient to gain his confidence and cooperation. Explain how the patient can help
you.
2. Provide privacy by means of screens.
3. Place the articles conveniently on the bedside table.
Algorithm of actions:
1.
Wash hands. Wear protective clothes (gown mask and cap). Reason – The gown and cap protect
the nurse from the infestation with lice.
2 . Spread out oilcloth, seat the patient on a chair or couch.
3 . Part the hair into small sections and apply the parasiticide on the hair and scalp, rubbing gently. In
long hair, the medicine is to be applied along the whole length of the hair. Reason – Thorough
application of the parasiticide ensure thorough destruction of the lice.
4 . Roll up the long hair to the top of the head and cover the had with the cap or triangular bandage or
by a towel folded diagonally. Secure it with pins. Sustain the necessary time, according to
methodical instructions on the medication. Reason - Covering the head with the towel prevents the
spread of the lice to other areas of the body.
5 . Wash off medication with warm water and with shampoo.
6. Rinse hair with warm water and 6% vinegar.
7. Carefully comb out lice and nits louse with comb.
8. Disinfect object of care and protective clothes.
9. Make an entry in the patient's medical document. Marking «P» on the title page of Medical hospital
card (medical history).
10 . Process the room.
N.B. After 7 days to see the patient again. If necessary, repeat the procedure.
Parasiticides Used in the treatment of
pediculosis
1.Ниттифор
2. Педилин
3. Пара плюс
4.Паранит
The instruction to the drug Nittifor
•
Method of application and dose:
Hair is liberally moistened with a solution with a cotton swab, rubbing the drug into the hair
roots. Consumption per person - 10 to 60 ml, depending on the density and length of hair. After
the treatment the head is covered with scarf, and after 40 min drug wash off with warm running
water with soap or shampoo. After washing a hair comb to remove dead insects. If live lice are
found 7 days after treatment is recommended to repeat the treatment.
•
In the case of existing danger of re-infection in a group (school, kindergarten) medicine to apply
after shampooing and leave it on the hair after drying. Applied to the hair, the drug retains its
activity for approximately 2 weeks (does not allow to reproduce again caught hair lice). To
repeat the treatment after every hair wash. The dead nits are removed from hair with a thick
comb or one, because they are firmly attached to the hair.
Solution. A bottle containing 24 ml of the drug, calculated on a three-day course of treatment.
For ease of use on the bottle marks.
Applied externally in the form of freshly prepared 0.4% aqueous emulsion, for which 1/3 of the
contents of the vial (8 ml) is added to 100 ml of boiled water at room temperature. The finished
emulsion 1 time a day (at night) thoroughly rubbed into the skin of the upper extremities, torso,
and then lower extremities.
Not be processed skin of the face and neck, and scalp. At the end of the treatment on the fourth
day the patient should take a shower and to hold a change of underwear and bed linen.
Transport patients
Method of transportation of the patient in the hospital:
1. On a stretcher (gurney)
2. A wheelchair
3. On foot (accompanied by medical personnel – nurse!)
REMEMBER
• The doctor conducting the examination, determines the method of
transportation of the patient.
• Necessary take into account the patient's condition.
• Seriously sick (can not move) are transported to the office on a
stretcher or in a wheel chair. Means of transport (wheelchairs,
stretchers) are provided with sheets and blankets that must be
replaced after each patient.
• Patients that move independently from admissions go to the
house accompanied by nurses.
Means of transport:
• wheelchairs
• gurney
• stretchers
Algorithm. Transportation a patient
on a stretcher (gurney)
1.
Wear gloves.
2.
Cover the stretcher with bedsheet.
3.
Shifting the patient from bed to stretcher:
Put the head end of the stretcher perpendicular to the foot end of the bed (medical couch). If the area the house
is small, put the stretcher parallel to the bed (figure 1).
If three medical personnel: first nurse put hands under the head and shoulder of the patient, second - the pelvis
and the upper part of the hips, third - under the middle of the thighs and shins.
If two medical personnel: first nurse put hands under the neck and shoulder of the patient, second - under the
lower back and knees.
4.
Raise the patient, turn in the direction of stretcher on 90 ° (perpendicular shifting) or on 180 ° (parallel
shifting).
5.
Place the patient on a stretcher, cover him.
6.
Carry the stretcher (roll the gurney) in the department by head forward to evaluate possible changes
patient's condition.
7.
In the ward put the head end of the stretcher to the foot end of the bed.
8.
Shifting the patient from stretcher to bed (rules above).
9.
Process the stretcher.
10. Put gloves in disinfectant.
11. Wash hands.
Figure 1
Transportation on a stretcher
• Carry a patient on a stretcher should be without
haste and shaking. Carry the patient down the stairs
feet toward. Carry the patient Up the stairs, the head
forward.
Shifting the patient from bed to
wheelchairs
:
INPATIENT DEPARTMENT
(therapeutic department)
The staff of the Inpatient department:
• Head of Department
• Doctors (clinical intern)
• Senior nurse
• Ward nurse
• Treatment nurse (procedural nurse)
• Junior nurse
SENIOR NURSE - the most experience nurse of department.
Functions:
• organize the work of Ward and Junior nurses;
• supply the drug, medical equipment, medical instruments in
Inpatient department for nursing care
• strict accounting of narcotic and toxic drugs.
WARD NURSE
Functions:
1. Admission patients.
2. Carry out of nursing examination (weight, height,
thermometry, blood pressure, pulse).
3. Organization General nursing. The provision of hospital
regimes, personal hygiene, motor activity, nutrition,
pharmacotherapy.
4. Organization Special nursing (depends on the disease).
TREATMENT NURSE
Functions:
1. perform doctor’s appointments (parenteral methods of administration subcutaneous, intramuscular, intravenous injections, intravenous infusion)
2. helps the doctor during manipulation (for example, determination of
blood group).
3. take of a blood from a vein for biochemical research.
JUNIOR NURSE
Functions:
1. Regular wet cleaning of Inpatient department .
2. Sanitary and hygenic processing of the patients.
3. Transportation of patients.
4. Implementation nursing for the seriously ill (Help to Ward nurse).
5. Disinfection of used subjects of care for patient.
6. Сollecting and disposing of medical waste.
The structure of the Therapeutic Inpatient
department:
1.
2.
3.
4.
5.
6.
7.
8.
Nursing station (office)
Wards for patients.
Treatment room.
Manipulational room - Cabinet for medical
procedures (such as enema, sensing and other
manipulation).
Rooms for medical staff.
Dining room.
Shower room.
WC (toilet room).
Nursing station. Organization the work of
nursing station
Nursing station (office) - It is workplace of
Ward nurse, located in the hall.
Function - Admission patients.
Equipment nursing station
1. Table
2. Chairs (2 - 3)
3. Telephone.
4. Capboard for medicines.
5. Table lamp
6. Clock.
7. Refrigerator for foodstuff.
8. Signalization.
9. Device to measure blood pressure
10. Medical scales
11. Height meter
Admission is a process of receiving a new patient to an individual unit (ward) of
the hospital.
Admission patients includes:
1. Check for orders of admission.
2. Assess the patient's immediate need and take action to meet them. These
needs can be physical (e.g. acute pain) or emotional distress, (upset).
3. Make introduction and orient the patient.
4. Perform baseline assessment of patients:
•
Consciousness
•
Temperature
•
Pulse
•
Respiration
•
blood pressure.
•
Measure the weight of the patient
•
Waist size
•
Height is measured (if required)
5. Documentation
Types of consciousness:
1) clear consciousness - Adequate reaction to the
environment.
2) disturbed consciousness:
• The stupor. The patient sleeps poorly oriented in space,
possibly involuntary discharge of urine and feces, the
response to verbal and painful stimuli is weakened.
• Sopor. Deep stage stun, the patient does not respond to
verbal treatment, but the reaction to painful stimuli saved.
• Coma. Complete loss of consciousness, loss of reaction to
external stimuli, involuntary discharge of urine and feces.
• Mental stimulation – hallucinations, nonsense.
An algorithm for the measurement of body weight
Equipment.
• Medical electronic scales
• Oilcloth (or disposabl napkin)
• GlovesMedical documentation (temperature sheet)
• Сontainer for disinfection
Algorithm:
• Explain to the patient the purpose and procedure course. Obtain patient’s consent.
• Conduct hygienic washing hand and processing hand. Put the gloveson.
• Put on the surface of scales the oilcloth (or disposabl napkin).
• The patient must remove their shoes.
• The patient must carefully stand on the center platform on the oilcloth.
• Remember result.
• Ask the patient get off on the floor carefully.
• Offer the patient put on shoes and walk to the ward.
• Conduct disinfection used material (or utilization napkin).
• Take the gloves off and put them in the container for disinfection.
• Wash hands hygienic way.
• Make a record of results in a medical documentation.
Algorithm measurement the growth of the patient
Equipment.
• Medical stadiometer
• Oilcloth (or disposabl napkin)
• Gloves
• Medical documentation (temperature sheet)
• Сontainer for disinfection
Algorithm:
• Explain to the patient the purpose and procedure course. Obtain patient’s consent.
• Conduct hygienic washing hand and processing hand. Put the gloves on.
• You must cover the platform of the stadiometer with an oilcloth (or disposabl napkin). The patient
must remove their shoes and cap.
• Ask the patient to stand on a platform of stadiometer, covered with oilcloth.
• Explain what patient must strengthen your back during the measurement of growth, to touch vertical
strips by four points: neck, shoulders, buttocks and heels.
• Check the position of the patient's head. The line connecting the external corner of the eye and upper
edge of ear must be horizontal.
• Lower the measuring bar on the top of the head of the patient. To fix the bar with hand.
• Ask the patient get off on the floor.
• Offer the patient put on shoes and walk to the ward.
• Conduct disinfection used material (or utilization napkin).
• Take the gloves off and put them in the container for disinfection.
• Wash hands hygienic way.
• Make a record of results in a medical documentation .
• Anthropometry - evaluation of human body by
measuring height and body weight.
• Today in clinical practice is widely used calculation of
body mass index (BMI) which is calculated by the
formula:
BMI=body weight (kg) / height2 (m).
• The ideal BMI is 24.
• In this BMI, the mortality rate of man minimum. A
BMI of over 30 means obesity, less than 18 underweight.
The waist size
• In normal waist
circumference (FROM)
women should not exceed
80 inches, and for men 94
cm.
• If the circumference of
your waist is higher than
normal, then you are at risk
of cardiovascular diseases
and type II diabetes.
Patient Care Unit
Patient Care Unit: is the space where the patient is accommodated in
hospital or patient home whereto receive care.
The patient unit in the hospital is of three types:
1. Private room – is a room in which only one patient be admitted
2. Semi private room – is a patient unit which can accommodate
two patients
3. Ward - is a room, which can receive three or more patients.
Patient Care Unit сonsists of a hospital bed, bed side stand, chair,
overhead light, waste container and others as needed and
available.
Hospital Bed. Gatch bed: a manual bed which requires the use of
hand racks or foot pedals to manipulate the bed into desired
positions i.e. to elevate the head or the foot of the bed
Types of Hospital Regime:
1.
2.
3.
4.
Therapeutic protective regime
Individual (motor ) regime
Hygienic regime
Sanitation and epidemiological regime.
1. Therapeutic protective regime - a system of
rules for providing physical and psychological
well being of patients. Events:
• Eliminate the negative visual emotions
• Strict compliance with day regimen at the hospital.
• Qualified medical aid.
• Compliance with medical ethics and deontology.
Individual motor regime – the amount of patient`s physical activity.
Types:
• strict bed rest regime
• bed rest regime
• ward regime
• free regime
Strict bed regime - A patient must not move yourself and change
position in bed. For example: The strict bed regime is prescribed by
the doctor during the first hours after surgery, myocardial infarction,
and others.
Bed rest regime - The patient may move only in bed. This regime is
prescribed in order to increase motion activity while recovery.
Ward regime - The patient may sit, stand, walk carefully in hospital ward.
Free regime -The patient may move freely within a ward or department.
2. Hygienic regime - a system of requirements for
hygienic conditions at the hospital.
For example:
•Walls in the wards must be painted with oil-based paint. No wallpaper on the
walls. Such walls are difficult to wash.
•Beds must be made ​of metal, because beds made of wood can soak up blood,
urine and so on.
•Walls in the medical treatment room must be tiled.
3. Sanitation and epidemiological
regime – a set of measures to prevent
the appearance and spread of
infection at the hospital.
Medical secrecy
All information received by a medical worker about the patient - is a
medical secrecy.
Medical secrecy includes:
• information about the treatment in the hospital;
• information about a person`s health status;
• information about the diagnosis;
• other information received during the examination and treatment.
A doctor in Russia can violate the medical secrecy in the following
situations:
1) If a patient has mental disorders, therefore, they can not express their
will;
2) if there is the threat of infectious disease dissemination
or poisoning;
3) if there is a criminal investigation;
4) If the patient is a child;
5) If the disease is a result of violent act.
For example, a knife wound.
Iatrogenic illnesses
An incompetent medical worker may do harm to the
patient.
The consequences of the medical negative action are
called “Iatrogenic illnesses”.
Types of iatrogenic illnesses:
• psychogenic iatrogeny
• medicamental iatrogeny
• manipulation iatrogeny
• «Silent» iatrogeny
• Psychogenic iatrogeny – the pathology, caused
by careless words and actions of the doctor.
• Medicamental iatrogeny – is a result of drug
effect. For example, side effects of some
medicines (such as nausea, allergy, weakness and
other).
• Manipulation iatrogeny – is a complication,
appeared during medical procedures. For example,
inflammation in the injection site.
• «Silent» iatrogeny - a result of inaction of a
medical worker. For example, a doctor passed by
an injured person in the street